To determine whether the current liver screening program for fatty liver has sufficient scientific evidence to justify its continued implementation. The liver screening program to detect fatty liver was performed on 411 Japanese workers utilizing serum aspartate aminotransferase (ALT), alanine aminotransferase (AST), and gammaglutamyl transpeptidase (γ-GTP). Based on the preceding studies, subjects with viral and alcohol hepatitis were excluded from the evaluation. The diagnosis of fatty liver was based on ultrasound findings. The program was evaluated by efficacy and effectiveness; efficacy was measured according to the receiver operating characteristic (ROC) curves in comparison with the Body Mass Index (BMI). Effectiveness, based on the efficacy determinations, was assessed by means of the positive predictive value (PPV) test performance, the disease characteristics, and the program price.The diagnostic performances of ALT and BMI were nearly acceptable but far from excellent. The areas under the curves of the two indices were 0.69 and 0.63, respectively and these were statistically equivalent. The PPV ranged from 15 to 28% where the prevalence of fatty liver was 12.3%. The price of the program was estimated at US 4 dollars per person based on the medical reimbursement fee rate. The efficacy of the liver screening program was found to be insufficient and BMI monitoring may provide a more suitable and inexpensive alternative. Furthermore, the effectiveness of the program is open to question, considering the generally benign prognosis of the disease in the absence of any accompanying morbid conditions and the high price of the program.

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Carcinogenicity and chronic toxicity of N,N-Dimethylformamide (DMF) were examined by inhalation exposure of groups of 50 rats and 50 mice of both sexes to DMF vapor at a concentration of 0, 200, 400 or 800 ppm (v/v) for 6 h/d, 5 d/wk, for 104 wk. In rats, incidences of hepatocellular adenomas and carcinomas significantly increased in the 400 and 800 ppm-exposed groups and in the 800 ppm-exposed group, respectively. The hepatocellular adenoma did not increase significantly in the 400 ppm-exposed female rats, but its incidence exceeded a range of historical control data in the Japan Bioassay Research Center (JBRC). In mice, incidences of hepatocellular adenomas and carcinomas significantly increased in all the DMF-exposed groups. Incidence of hepatoblastomas significantly increased in the 200 and 400 ppm-exposed male mice, and 4 cases of hepatoblastomas in the 400 ppm-exposed female mice and the 800 ppm-exposed male mice exceeded the range of historical control data of the JBRC. Incidences of altered cell foci increased in the liver of exposed rats and mice in an exposure concentration-related manner, and those foci were causally related to the hepatocellular tumors. Liver weights increased in both rats and mice exposed to DMF at 200 ppm and above. Increased levels of γ-GTP, ALT, AST and total bilirubin in exposed rats of both sexes and AST and ALT in exposed mice of both sexes were noted. It was concluded that 2-yr inhalation exposure to DMF increased incidences of hepatocellular adenomas and carcinomas in rats and incidences of hepatocellular adenomas, carcinomas and hepatoblastomas in mice, and that hepatocarcinogenicity of DMF was more potent in mice than in rats.

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The two major causes of bladder cancer have been recognised to be cigarette smoke and occupational exposure to arylamines. These compounds are present both in tobacco smoke and in the dyes used in textile production. Aromatic amines suffer oxidative metabolism via P450 cytochrome CYP1A2, and detoxification by the polymorphic NAT2. The aim of the present work was to assess the association between occupational-derived exposure to mutagens and CYP1A2 or NAT2 activity. This cross-sectional study included 117 textile workers exposed to dyes and 117 healthy controls. The urinary mutagenicity was determined in 24 h urine using TA98 Salmonella typhimurium strain with microsomal activation S9 (MIS9) or incubation with β-glucuronidase (MIβ). Urinary caffeine metabolite ratios: AFMU+1X+1U/17U, and AFMU/AFMU+1X+1U were calculated to assess CYP1A2 and NAT2 activities, respectively. The results show that workers present a strikingly higher urine mutagenicity than controls (p<0.0001), despite the implementation of the new restrictive norms forbidding the industrial use of the most carcinogenic arylamines. Neither NAT2 nor CYP1A2 activity had any effect on the markers of internal exposure to mutagens, since no significant differences were observed when the urinary mutagenicity of slow and fast acetylators (p>0.05) was compared, and the urinary mutagenicity was not significantly associated with the CYP1A2 activity marker (r=0.04 and r=-0.01 for MIS9 and MIβ, respectively). This study clearly indicates the need for further protective policies to minimise exposure to the lowest feasible limit in order to avoid unnecessary risks.

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A questionnaire survey was conducted with questions from the 12-item General Health Questionnaire, among others, targeting 4,407 nurses in 8 general hospitals in Japan, in the hope of improving the work environment of nurses and to provide data that will allow a discussion of the measures necessary for preventing medical errors, thus improving occupational health. For each type of accident, the percentage of those who had made medical errors was significantly higher for the “mentally in poor health” group than for the “mentally in good health” group (p<0.0001). The percentage of nurses in the “mentally in good health” and “mentally in poor health” groups who had experienced occupational accidents over the past 12 months (i.e., whether they were “with errors” or “without errors”) was calculated for each of the following four types of medical accident: (1) drug-administration errors, (2) incorrect operation of medical equipment, (3) errors in patient identification, and (4) needlestick injuries. For each type of accident, the percentage of those who had made medical errors was significantly higher for the “mentally in poor health” group than for the “mentally in good health” group (p<0.0001). Multiple logistic regression analyses revealed significant associations between experience of medical errors in the past 12 months and being mentally in poor health, with night or irregular shift work, and age.

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The study investigated the overall effectiveness and its determinants of an influenza vaccination in the reduction of Acute Respiratory Illness (ARI) clinic visits and sickness absence for a working population. We collected and compared the data of clinic visits and hours of sick leave among vaccinated and non-vaccinated workers during January and April in 1998 and 1999. A multiple regression analysis was conducted to explore possible determinants. The incidence rate of ARI clinic visits dropped 37.9% in 1999, with 57.3% reduction in vaccinated and 14.1% in un-vaccinated workers. Multiple regression analysis showed that the reduction was significantly associated with vaccination status, a history of diabetes, and occurrence of ARI clinic visits in 1998. Influenza vaccination is effective in reducing ARI clinic visits and sickness absence. Workers with a previous history of ARI, diabetes, and possibly young workers living with children were more likely to get the benefit. The identification of potential susceptible subpopulations can also minimize confusion on company policy for isolation during an epidemic of new infectious disease with flu-like symptoms.

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To improve the satisfaction of people who had periodical worksite health check-ups, we conducted a questionnaire survey. It is possible that a portion of the health check-up participants who have a medical history of serious disease may have different expectations of periodical health check-ups compared to healthy individuals. We conducted the analysis by dividing the participants into three groups: those with a medical history of serious disease, those without a medical history of serious disease, and the whole group of those with and without a medical history of serious disease. There were 50 individuals with a medical history of serious disease and 226 without a medical history of serious disease. There were 231 males and 45 females. The average age was 40.3 yr (range: 21-64). To investigate the factors that influence overall satisfaction, we conducted multiple linear regression analysis by a stepwise method, with overall satisfaction as a dependent variable, and attributes of health check-up participants, factors related to the physician, factors related to the examination, and indirect factors such as waiting time as independent variables. The selective criterion for the variables was that the p value was less than 0.05, but sex and age were always included in the final model as independent variables because they might be confounding factors. In the whole group of those with and without a medical history of serious disease, overall satisfaction was significantly associated with the technical level of the person in charge of the examinations, the explanation of the person in charge of the examinations, the time spent for examination, the content of the interview with physicians and interview time with physicians. In the group with a serious disease medical history, overall satisfaction was significantly associated with the explanation of the person in charge of the examinations and interview time with physicians. In the group without a serious disease medical history, overall satisfaction was significantly associated with age, the technical level of the person in charge of the examinations, the time spent for examinations, the content of the interview with physicians and interview time with physicians.

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This study assessed the relationship of age, poor perception of working condition, poor safety environment, poor management and supervision, risk-taking behavior, emotional instability, negative job involvement, job dissatisfaction, job stress, and poor safety performance of workers to occupational injuries. This case-control study was conducted on 202 male coal miners with at least one occupational injury during a five-year period and 202 male controls with no occupational injury, matched on the job. A standardized questionnaire administered by individual interviewers was used. Data were analysed by the logistic regression method. For all workers combined, the factors with significant adjusted odds ratios (ORs) found were: 30-45 and >45 yr age groups (OR vs. <30 yr age group: 1.80, 95% CI 1.02-3.17 and 2.59, 1.38-4.85 respectively), poor perception of working conditions (1.61, CI 1.00-3.18), emotional instability (2.33, 1.04-5.22), job stress (1.83, 1.00-3.46) and poor safety performance of workers (3.10, 1.45-6.63). No significant interaction was found between these risk factors and the job. It was concluded that older age, poor perception of work conditions, poor work environment, and human behavioral factors played significant roles in occupational injuries. This information would help in implementing preventive programs to improve working conditions and management quality and to help the workers to develop positive psychological traits, but workers with negative traits such as emotional instability and older workers should be employed in less demanding jobs.

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This paper presents a field evaluation of a passive badge for measuring 2-ethoxyethyl acetate (2-EEAc) in a humid working environment. Forty-eight pairs of side-by-side active/passive 8-h full-shift personal samples were collected to evaluate the performance of a passive badge for monitoring 2-EEAc with the co-exposure of toluene and methyl iso-butyl ketone (MIBK) in a warm and humid workplace. Sixteen pairs of side-by-side passive badges, active charcoal tubes, and active charcoal tube with drying tube samples were also compared to evaluate the humidity effect in sampling. No statistical difference was found between the passive and active samples in assessing 2-EEAc. Linear regression showed the correlation to be high (r=0.987, slope=1.018, n=48) over the range 0.42-41.5 ppm. The mean concentration difference was 0.53 ppm and the mean relative error was 5.39%. Close correlation was also found between passive and active samples for assessing both toluene (r=0.949, slope=0.918, n=16), and MIBK (r=0.943, slope=1.098, n=16). Similar high correlation (r>0.962, n=16) was found among passive badges, active charcoal tubes, and active charcoal tube with drying tube samples. The humidity effect and the interference of co-exposure of polar and non-polar solvents were insignificant at a low sampling rate (26.6 ml/min) in assessing 2-EEAc exposures. The use of the passive samplers produces comparable findings to that of active sampling.

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The aim of this study was to investigate the level of job satisfaction among physiotherapists, and to identify the best predictors of job satisfaction. A self-administrated questionnaire survey was conducted in September 2003. Data were collected from 198 physiotherapists in 13 health care settings (five university hospitals, seven government hospitals, and one municipality hospital) located in Ankara, Turkey. Respondents were asked to complete a 31-item job satisfaction questionnaire. The response rate was 79.8%. The percentage of satisfied physiotherapists was 45.5%. There were no significant satisfaction differences between genders or between age groups. There was a positive relationship between the global satisfaction and domain scores (all ps<0.01). Logistic regression analysis showed that the most important predictors of job satisfaction were: (1) Leadership (OR=1.03, 95% CI 1.01 to 1.06), (2) Interpersonal relationships (OR=1.03, 95% CI 1.00 to 1.05), (3) Advancement (OR=1.02, 95% CI 1.00 to 1.05), and (4) Salary (OR=1.02, 95% CI 1.00 to 1.04). Specific job satisfaction dimensions indicate that highest dissatisfaction levels occur in the area of salary and advancement. Areas of dissatisfaction are signals for change.

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